Loperamide overdose-induced catatonia: potential role of brain opioid system and P-glycoprotein.

OBJECTIVE: Catatonic features are observed in several psychiatric illnesses but can also be found following substance misuse. Loperamide is an anti-diarrhoeal medication that acts on opioid receptors in the intestine, reducing peristalsis. It is normally unable to pass through the intestinal wall or the blood-brain barrier; however, high dosages can in fact induce the effects on the central nervous system. CASE REPORT: We describe the case of a 20-year-old man who presented with severe catatonia following excessive intake of loperamide, fully remitted with lorazepam. CONCLUSION: We speculate on a possible increase of loperamide's bioavailability after overdose owing to reduced expression and functioning of P-glycoprotein.

[Mobbing: between personality traits and organizational-managerial characteristics of the occupational environment]. / Mobbing: tra struttura di personalità e caratteristiche organizzativo-- gestionali dell'ambiente lavorativo.

UNLABELLED: INTRODUCTION. The relationship between stressful events in the workplace and their effect on health is the subject of numerous studies where the phenomenon of"Mobbing" has become of increasing interest in Social Psychiatry and Occupational Medicine. The aim of this study is to evaluate the relationship between mobbing, occupational stress and personality structure in a group of persons who consulted the "Work Adaptation Disorders Centre" at the Institute of Occupational Medicine between December 2008 and June 2010 for mobbing-related issues. METHODS: Referring to Leymann Inventory of Psychological Terrorization (LIPT), H. Ege, Occupational Stress Indicator (OSI), Minnesota Multiphasic Personality Inventory 2 (MMPI-2), it has been possible to assess situations of harassment, the sources and the effects of work stress, as well as personality traits in the study group. RESULTS: The results showed that high levels of occupational stress and inadequate coping strategies can lead to depressive, hysterical and paranoid manifestations. CONCLUSIONS: Although the relationship between mobbing, occupational stress and personality traits still remains controversial, there is an association between perception of adverse behaviour and mental health, regardless of the subject's ability to cope with stressful life events. The data seem to confirm that the prevention of bullying must be implemented by the work organization and by handling interpersonal conflicts in the work context.

Levetiracetam in tardive dyskinesia.

OBJECTIVES: The aim of this study was to evaluate the effect of levetiracetam on tardive dyskinesia (TD), which is known to be a major limitation of chronic antipsychotic drug therapy, particularly with conventional antipsychotics. METHODS: Sixteen patients suffering from chronic psychosis with TD were enrolled consecutively. Levetiracetam was given in gradually increasing doses, starting with 125 twice a day until the best clinical benefit was achieved (mean dosage, 2,290 mg; range, 1,000-3,000 mg). Tardive dyskinesia was assessed using the Abnormal Involuntary Movement Scale at baseline and after 1 month and 3 months of treatment with levetiracetam. RESULTS: Compared with baseline, there was a significant improvement in the Abnormal Involuntary Movement Scale score after 1 month still present after 3 months (P < 0.001). All patients well tolerated levetiracetam, except one who dropped out of the trial after the first 2 weeks owing to excessive drowsiness. CONCLUSIONS: The results of this open-label observational study suggest that levetiracetam is a well-tolerated drug and effectively controls TD.

Quetiapine and clozapine in parkinsonian patients with dopaminergic psychosis.

OBJECTIVE: This study aimed to compare the efficacy and safety of quetiapine and clozapine in parkinsonian patients with dopaminergic psychosis in a randomized, open-label, blinded-rater, parallel group trial. METHODS: Forty-five patients with Parkinson disease (PD) and psychosis induced by antiparkinsonian drugs were randomly assigned to receive either quetiapine or clozapine. The duration of the trial was 12 weeks. Forty patients, 20 in each treatment group, completed the study. The final dose of quetiapine (mean +/- SD) was 91 +/- 47 mg/d and that of clozapine 26 +/- 12 mg/d. The severity of psychosis was assessed using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression Scale-Severity Subscale (CGI-S). The Unified Parkinson's Disease Rating Scale (UPDRS) III was used to assess motor conditions during the study period. The Abnormal Involuntary Movement Scale (AIMS) was performed to evaluate dyskinesias. RESULTS: Forty patients, 20 on clozapine and 20 on quetiapine, completed the study. The psychopathologic state improved significantly (P < 0.001) from baseline in both treatment groups. No differences were found between clozapine and quetiapine at any assessment time. Motor conditions remained unchanged after clozapine and quetiapine. Dyskinesias decreased significantly (P < 0.05) in both groups. Side effects were mild, generally transient, and well tolerated. CONCLUSIONS: Quetiapine and clozapine appear equally efficacious for treatment of dopaminergic psychosis in patients with PD.

The effect of mirtazapine augmentation of clozapine in the treatment of negative symptoms of schizophrenia: a double-blind, placebo-controlled study.

The development of therapeutic strategies to effectively treat negative symptoms remains one of the primary goals in the treatment of schizophrenia. Mirtazapine is the first of a new class of dual action compounds, the noradrenergic and specific serotonergic antidepressants (NaSSa), whose activity is related to the enhancement of noradrenergic and serotonergic transmission by a presynaptic alpha2 antagonism and postsynaptic 5-HT2 and 5-HT3 antagonism, respectively. This study was a 8-week double-blind, randomized, placebo-controlled trial of 30 mg adjunctive mirtazapine to clozapine therapy in 24 patients with DSM-IV schizophrenia. The main finding at the end of the trial was a significant reduction on the Scale for the Assessment of Negative Symptoms (SANS) total scores in the mirtazapine group compared to placebo (P<0.01) with a significant improvement on the SANS subscales avolition/apathy and anhedonia/asociality. The Brief Psychiatric Rating Scale total score at week 8 showed superiority of mirtazapine over placebo. These findings suggest a potential role for mirtazapine as an augmentation strategy in the treatment of negative symptoms of schizophrenia.

Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder.

The aim of the present study was to investigate the effect of adjunctive olanzapine in patients with obsessive-compulsive disorder (OCD) refractory to paroxetine. Twenty-one patients unresponsive to treatment with paroxetine, administered for at least 12 weeks at the dose of 60 mg/day, participated to a 12-week open-label, add-on trial with olanzapine (10 mg/day). The psychopathological state was evaluated by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and by Clinical Global Impression (CGI). Three patients did not complete the 12-week adjunctive treatment with olanzapine. In the 18 completers, the mean Y-BOCS score decreased significantly from 27.1+/-4.0 at baseline to 20.1+/-3.9 at final evaluation (P<.001). Seven patients (38.9%) were rated as responders at final evaluation. Steady-state plasma concentrations of paroxetine were not modified during olanzapine coadministration. The drug combination was generally well tolerated and initial sedation and weight gain were the most frequent unwanted effects. Our findings confirm the results of previous studies and indicate that the addition of olanzapine to ongoing treatment with serotonin reuptake inhibitors (SRI) may be beneficial in some patients unresponsive to SRI monotherapy.

Interleukin-18 and CD30 serum levels in patients with moderate-severe depression.

Interleukin-18 (IL-18), a pro-inflammatory cytokine that plays an important role in the T-cell-helper type 1 response, is a new member of the family of cytokines produced in the brain. CD30 is a marker of T-cell-helper type 2 lymphocytes. We evaluated IL-18 and CD30 serum levels in 10 patients affected by moderate-severe depression (MSD). We demonstrated for the first time that serum IL-18 levels of MSD patients were significantly higher than those of healthy donors. On the contrary, no significant difference was found between serum CD30 levels of MSD patients compared with those of healthy donors. These data strengthen the hypothesis that MSD disease is associated with an inflammatory response, mainly T-cell-helper type 1, and suggest an important role for IL-18 in the pathophysiology of MSD.